DIGESTIVE DISORDERS

DIARRHEA
Diarrhea describes bowel movements (stools) that are loose and watery. It is very common and usually not serious. Many people will have diarrhea once or twice each year. It typically lasts two to three days and can be treated with overthe-counter medicines. Others have diarrhea often as part of irritable bowel syndrome or other chronic diseases of the large intestine.
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CAUSES Infection by bacteria (the cause of most types of food poisoning) Infections by other organisms Eating foods that upset the digestive system Allergies to certain foods Medications Radiation therapy Diseases of the intestines (Crohn's disease, ulcerative colitis) Malabsorption (where the body is unable to adequately absorb certain nutrients from the diet) Hyperthyroidism Some cancers Laxative abuse Alcohol abuse Digestive tract surgery Diabetes Competitive running Inadequate water intake. Inadequate fiber in the diet. A disruption of regular diet or routine; traveling. Inadequate activity or exercise or immobility. Eating large amounts of dairy products. Stress. Resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids. Overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles. Hypothyroidism. Neurological conditions such as

PREVENTION/TREATMENT If you have a mild case of diarrhea, you can just let it run its course, or you can treat it with an over-the-counter medicine. Common brand names include Pepto-Bismol, Imodium A-D, and Kaopectate, which are available as liquids or tablets. Follow the instructions on the package. In addition, you should drink at least six 8-ounce glasses of fluid per day. Choose fruit juice without pulp, broth, or soda (without caffeine). Chicken broth (without the fat), tea with honey, and sports drinks are also good choices. Instead of drinking liquids with your meals, drink liquids between meals. Drink small amounts of fluids frequently.

CONSTIPATION
Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or feces become harder and more difficult to pass.

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Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain bread and cereal (especially bran). Fiber and water help the colon pass stool. Drink 1 1/2 to 2 quarts of water and other fluids a day (unless fluid restricted for another medical condition). Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until your bowel habits return to normal. Some people may need to avoid milk, as dairy products may be

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Parkinson's disease or multiple sclerosis. Antacid medicines containing calcium or aluminum. Medicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills). Depression. Eating disorders. Irritable bowel syndrome. Pregnancy. Colon cancer.

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constipating for them. Exercise regularly. Move your bowels when you feel the urge.

If you are constipated, try the following:

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In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

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Drink two to four extra glasses of water a day (unless fluid restricted). Try warm liquids, especially in the morning. Add fruits and vegetables to your diet. Eat prunes and/or bran cereal. If needed, use a very mild stool softener or laxative (such as PeriColace or Milk of Magnesia). Do not use laxatives for more than two weeks without calling your doctor, as laxative overuse can aggravate your symptoms.

FLATULENCE
It is the state of having excessive stomach or intestinal gas. This can result in uncomfortable feelings of bloating, as well as increased belching or passing of gas from the rectum.

Excess gas in the digestive tract (which is your esophagus, stomach, small intestine, and colon/large intestine) can come from 2 sources: increased intake of gas, for example, from air you swallow; or increased production of gas as certain undigested foods are broken down by harmless bacteria normally found in your colon.
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Experience has shown that the most common ways to reduce the discomfort of gas are changing diet, taking medicines, and reducing the amount of air swallowed.

Swallowed air (aerophagia): This can occur with improper swallowing while eating or even unconscious swallowing of air out of habit. Activities that cause you to swallow air include rapid drinking, chewing gum, use

Flatulence is most often related to diet, and sometimes to those habits that cause you to swallow air. You can begin by trying to remove the problem foods from your diet. For many people, this is a trial-and-error procedure.
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This may take some careful observation to notice what foods cause increased gas. Keep a food diary and note excess passage of gas.

of tobacco products, sucking on hard candy, drinking carbonated beverages, loose dentures, and hyperventilation in anxious people.
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Any of the gas-producing foods can be removed from your diet one group at a time until you see relief. Sorbitol and fructose are common offenders, so try these first.

in some soft drinks and fruit drinks. Dark beer and red wine Sorbitol: This sugar is found naturally in fruits including apples, pears, peaches, and prunes. It's also used as an artificial sweetener in sugar-free gum, candy, and other diet products. Fiber: Many foods contain soluble and insoluble fiber. Soluble fiber dissolves easily in Most people burp or belch to expel this excess swallowed air. The remaining gas moves into your small intestine. Air can be absorbed, but some moves along to the large intestine for release through the rectum. Analysis of the gas can help determine if it originated from aerophagia (mostly nitrogen, also oxygen and carbon dioxide) or GI production (mainly carbon monoxide, hydrogen, and methane). Breakdown of undigested foods: Your body does not digest and absorb some carbohydrates (for example, the sugar, starches, and fiber found in many foods) in the small intestine because of a shortage or absence of certain enzymes there. So this undigested food then passes from the small intestine into the large intestine, where normal, harmless bacteria break down the food, producing hydrogen, carbon dioxide, and, in about a third of all people, methane. Eventually

these gases exit through the rectum. Foods that produce gas in one person may not cause gas in another. Some common bacteria in the large intestine can destroy the hydrogen that other bacteria produce. The balance of the 2 types of bacteria may explain why some people have more gas than others. Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas. These common foods and their natural components may create gas: Beans: Beans contain large amounts of the complex sugar known as raffinose. Smaller amounts are found in cabbage, Brussels sprouts, broccoli, asparagus, and in other vegetables and whole grains. Starches: Most starches (potatoes, corn, noodles, and wheat) produce gas as they are broken down in the large intestine. Rice is the only starch that does not cause gas. Onions: The sugar known as fructose occurs naturally in onions, artichokes, pears, and wheat. It is also used as a sweetener water and takes on a soft, gellike texture in the intestines. Found in oat bran, beans, peas, and most fruits, soluble fiber is not broken down until it reaches the large intestine, where digestion causes gas. Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas. Wheat bran and some vegetables contain this kind of fiber. Lactase deficiency: Another major source of flatulence is lactase deficiency, which

results in a decreased ability to digest lactose, a natural sugar found in milk and other dairy products such as cheese and ice cream and in certain processed food such as bread, cereal, and salad dressing. This flatulence is often associated with diarrhea and cramping but can appear as only gas. Many people, particularly those of African, Native American, or Asian background, normally have low levels of the enzyme lactase needed to digest lactose after childhood. Also, as people age, their enzyme levels decrease. As a result, over time people may experience increasing amounts of gas after eating food containing lactose.
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Other problems: Certain conditions can result in other foods being poorly absorbed in the GI tract, allowing for increased bacterial activity. Malabsorption syndromes can be the result of decreased production of enzymes by the pancreas or problems with the gallbladder or lining of the intestines. If transit through the colon is slowed down for any reason, bacteria have increased opportunity to ferment remaining material. Therefore, if you are constipated or have decreased bowel function for any reason, flatulence can follow.

APPENDICITIS Appendicitis is an inflammation of the

Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer. Blockage may also occur from infection, since the appendix swells in response to any infection in

Surgery to remove the appendix, which is called an appendectomy, is the

appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. No one is absolutely certain what the function of the appendix is. One thing we do know: We can live without it, without apparent consequences. Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.

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standard treatment for appendicitis. If appendicitis is even suspected, doctors tend to err on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix. Antibiotics are given before an appendectomy to fight possible peritonitis. General anesthesia is usually given, and the appendix is removed through a 4-inch incision or by laparoscopy. If you have peritonitis, the abdomen is also irrigated and drained of pus. Within 12 hours of surgery you may get up and move around. You can usually return to normal activities in 2 to 3 weeks. If surgery is done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen), the incision is smaller and recovery is faster.

ULCERS
Peptic ulcers are holes or breaks in the protective lining of the duodenum (the upper part of the small intestine) or the stomach -- areas that come into contact with stomach acids and enzymes. Duodenal ulcers are more common than stomach ulcers. Comparatively rare are esophageal ulcers, which form in the esophagus -- or swallowing tube -- and are often a result of alcohol abuse.

While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Indeed, research conducted since the mid-1980s has persuasively demonstrated that the bacterium Helicobacter pylori (H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach

Fortunately, peptic ulcers are relatively easy to treat; in many cases they are cured with antibiotics, antacids, and other drugs that reduce the amount of acid produced by the stomach. There are also a variety of self-help and alternative treatments that can aid in relieving pain and in healing ulcers. Still, the dangers associated with peptic ulcers -- such as

ulcers. Other factors also seem to contribute to ulcer formation. Overzealous use of over-thecounter painkillers (such as aspirin, ibuprofen, and naproxen), heavy alcohol use, and smoking exacerbate and may promote the development of ulcers. Research indicates that heavy smokers are more prone to developing duodenal ulcers than are nonsmokers, that people who drink alcohol are more susceptible to esophageal ulcers, and that those who take aspirin frequently for a long period of time are more likely to develop stomach ulcers than those who don't. Other studies show that stomach ulcers are more likely to develop in elderly people. This may be because arthritis is prevalent in the elderly, and alleviating arthritis pain can mean taking daily doses of aspirin or ibuprofen. Another contributing factor may be that with advancing age the pylorus (the valve between the stomach and duodoneum) relaxes and allows excess bile (a compound produced in the liver to aid in digestion) to seep up into the stomach and erode the stomach lining. PARASITES Pinworms are a type of parasite that lives in the digestive system of humans. They are common throughout the world, especially in school-age children. Adult pinworms look like small, white threads that are no more than 0.5 in. (12.7 mm) long. Most people get pinworms by swallowing the worms eggs. This happens when someone with pinworms scratches around the anus, gets eggs on his or her hands (or under the fingernails), and touches you or a surface that you later touch. When eggs get on your hands or food and then you eat, the eggs go into your mouth. And they move into your

anemia, profuse bleeding, and stomach cancer -- are serious, so ulcers should always be monitored by your doctor.

You can treat pinworm infections with over-the-counter and prescription medicines. These medicines can help keep you from getting infected again and from spreading pinworms to other people. How do you keep from spreading

You need a microscope to see the eggs.

stomach and then to your rectal area.

pinworms or getting them again?

The eggs turn into worms in about a month. A To limit the chances of getting pinworm crawls out of the body during the pinworms or of spreading them to night and lays eggs on the skin around the others: anus. The wiggling motion when the worm lays eggs may irritate the skin and cause y Wash your hands carefully and itching. often. y Avoid scratching around your anus. Pinworms spread easily in families, day care y Keep your fingernails short. centers, schools, camps, and other places y Wash clothes and bedding where groups of people live. If one person in regularly. your family has pinworms, others probably do y Bathe and change your too. Pinworm infections can happen to anyone. They are not related to being unclean. underwear every day. If family members get pinworms again, all family members may need to take medicine to kill pinworms.

INDIGESTION Indigestion is often a sign of an underlying problem, such as gastroesophageal reflux disease (GERD), ulcers, or gallbladder disease, rather than a condition of its own. Also called dyspepsia, indigestion is a term used to describe a feeling of fullness or discomfort during or after a meal. It can be accompanied by burning or pain in the upper stomach.

If you are experiencing symptoms of indigestion, make an appointment to see your doctor to rule out a more serious Diseases: condition. Because indigestion is such a broad term, it is helpful to provide your y Ulcers doctor with a precise description of the y GERD discomfort you are experiencing. In y Stomach cancer (rare) describing your indigestion symptoms, y Gastroparesis (a condition where the stomach doesn't empty properly; this often try to define where in the abdomen the discomfort usually occurs. Simply occurs in diabetics) reporting pain in the stomach is not y Stomach infections detailed enough for your doctor to help y Irritable bowel syndrome identify and treat your problem. y Chronic pancreatitis y Thyroid disease First, your doctor must rule out any underlying conditions. Your doctor may Medications: perform several blood tests and you may

Indigestion has many causes, including:

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Aspirin and many other painkillers Estrogen and oral contraceptives Steroid medications Certain antibiotics Thyroid medicines

Lifestyle:
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have X-rays of the stomach or small intestine. Your doctor may also use an instrument to look closely at the inside of the stomach, a procedure called an upper endoscopy. An endoscope, a flexible tube that contains a light and a camera to produce images from inside the body, is used in this procedure.

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Eating too much, eating too fast, eating high-fat foods, or eating during stressful situations Drinking too much alcohol Cigarette smoking Stress and fatigue

HEPATITIS HEPATITIS B is a serious disease caused by the hepatitis B virus (HBV). Infection with this virus can cause scarring of the liver, liver failure, liver cancer, and even death. Hepatitis B is spread by infected blood and other bodily fluids such as semen, vaginal secretions, and open sores.

In most cases, hepatitis B causes limited infection. Usually people manage to fight off the infection successfully within a few months, developing an immunity that lasts a lifetime. (This means you won't get the infection again.) Blood tests show evidence of this immunity, but no signs of active infection. However, some people don't get rid of the infection. If you are infected with hepatitis B for more than six months, you are considered a carrier, even if you have no symptoms. This means that you can transmit the disease to others by having unprotected sex, exposing blood or open sores to another person, or sharing needles or syringes.

If you get to a doctor within two weeks after exposure to hepatitis B, you'll receive immediate vaccination and a shot of hepatitis immune globulin to boost the immune system to fight off the infection. But if you get sick, bed rest is usually necessary to speed recovery. Some doctors recommend a high-calorie, highfat diet and suggest that sufferers try to eat as much as possible despite the nausea.

Also, if you are infected with hepatitis B, take extra care of your liver. Do not For unknown reasons, the infection eventually drink alcohol, or take Tylenol goes away in a small percentage of carriers. (acetaminophen) as they can harm the For others, the infection becomes chronic. liver. Check with your doctor before Chronic hepatitis is an ongoing infection of taking any other drugs, herbal remedies,

the liver that can lead to cirrhosis. Cirrhosis, or supplements as some of them can or hardening of the liver, causes liver tissue to worsen liver damage. scar and stop working. If your hepatitis persists beyond six months and is in an active state (chronic If you are carrying the virus you should not donate blood, plasma, body organs, tissue, or active hepatitis B), your doctor may sperm. Tell your doctor, dentist, and sex prescribe much more aggressive partner that you are a hepatitis B carrier. treatment. If it is not active (inactive carrier state), your doctor may just watch you closely. People with chronic hepatitis are treated with a combination of drugs. These include:
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Interferon. The immune systemboosting medicine interferon alpha is injected for at least 6 months. This drug does not cure the disease, but improves liver inflammation. Longacting interferon (peginterferon) has also been shown to be useful. Interferon does have some undesirable side effects, including: malaise, depression, and loss of appetite, and it can lower the number of white blood cells. Epivir. This drug is taken orally once a day. Usually, the drug is well tolerated. Viral mutations often arise after prolonged use. Hepsera. This drug works well in people whose disease doesn't respond to Epivir but, in high doses it can cause kidney problems. Baraclude. This is the newest drug for hepatitis B. Viread. Monitoring kidney function

is needed with this treatment. To help keep hepatitis B infection from spreading:
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Get vaccinated (if you have not already been infected). Use condoms every time you have sex. Wear gloves when touching or cleaning up body secretions of others on personal items, such as bandages/Band-Aids, tampons, and linens. Cover all open cuts or wounds. Do not share razors, toothbrushes, manicuring tools, or pierced earrings with anyone. Do not share chewing gum or prechew food for a baby. Make certain that any needles for drugs, ear piercing, or tattooing are properly sterilized. Clean areas with blood on them with one part household bleach and 10 parts water.